Crisis. Mandated reporting. Elevation. When a seeker's needs reach beyond what spiritual care alone can hold.
A reference for biblical counseling and discipleship guides.
Welcome. This is Crisis and Elevation of Care. It applies to both tracks — biblical counseling and discipleship — because the three realities it covers can surface in either kind of relationship with a seeker. A crisis of imminent danger. A disclosure that triggers a mandated report. And the more common reality of elevation for clinical mental-health needs.
Here is the reassuring truth right up front. Most guides will never face a true crisis. Some will encounter a reportable disclosure. Many will, at some point, walk with a seeker whose needs require elevation. The way elevation lands looks a little different depending on which track you are on — that is one of the few places this deck speaks to the tracks separately, and we will come back to it.
Read this one through completely. Come back to Sections 2 through 4 before any first session, and again any time it has been a while. The procedures should be familiar enough that you do not have to look them up if a hard moment comes.
Three realities, and they are genuinely different from one another. The deck walks through each in order.
Crisis is imminent danger — to the seeker, or to someone else. The response depends on whether harm is actively unfolding or being seriously considered. 988 is the first call for crisis support and assessment. 911 is the first call when life is actively in danger. That distinction matters, and we will come back to it.
Mandated reporting covers two distinct paths. Ongoing abuse of a vulnerable person — a child, a dependent adult, an elder — gets reported to the Department of Social Services. A serious violent crime — homicide, sexual assault, and similar — gets reported to law enforcement. BetterFaith guides act as mandated reporters in both. Both paths include parallel notification to BetterFaith leadership.
Elevation of care is the most common reality. It happens any time a seeker's needs require clinical mental-health support beyond what spiritual care provides — depression that isn't lifting, anxiety beyond what pastoral conversation reaches, trauma needing therapy, and so on. Not always urgent. Always beyond a guide's scope. And this is one of the few places the deck speaks to the two tracks separately, because elevation lands differently in each. For discipleship, the relationship continues — clinical care is added alongside. For biblical counseling, the work often reaches a natural closure point and hands the seeker off to clinical care. Both are good outcomes, just different.
A guide does not diagnose mental health conditions, provide clinical therapy, advise on medication, treat substance use disorders, conduct clinical risk assessment, manage an active psychiatric crisis alone, investigate abuse, or determine the truth of an allegation about a crime. Stepping into clinical or investigative territory — even with good intentions — can quietly harm a seeker.
Before any of the procedures, the foundation. As a BetterFaith guide — on either track — your scope is spiritual care. That is the work you came to do, and it is real work.
There is also a clear list of things that are not yours to do. You do not diagnose mental health conditions. You do not provide clinical therapy. You do not prescribe or advise on medication. You do not treat substance use disorders. You do not conduct clinical risk assessment. You do not manage an active psychiatric crisis alone. You do not investigate abuse or decide whether an allegation is true. And you do not investigate criminal disclosures or determine whether what a seeker told you actually happened. The reason that line matters is not pride of place — it is that a guide who steps into clinical or investigative territory, even with the best intentions, can actually cause harm. By giving a seeker false confidence that a clinical need is being met when it is not. Or by interfering with work that belongs to professionals.
Spiritual care, clinical care, child protection work, and criminal investigation are all needed at different times. A seeker's full health usually involves more than one of them. Your job is to do your part well, and to recognize quickly when something else is needed.
Introduced in the consultation and reinforced in the first session. By the time something hard surfaces, it is too late to introduce these concepts. The first conversations do the work.
If you remember one thing from this whole document, let it be this. The most important preparation happens before there is any crisis or any disclosure. By the time a seeker is in crisis, or making a disclosure that triggers reporting, it is too late to introduce these ideas — they are not in a place to absorb new information. So the first conversations do the work.
A seeker should walk away from the consultation, and again from the first session, knowing three things plainly. One — what would actually happen, by situation. Different disclosures lead to different responses, and the seeker hears them named up front. Two — how it would feel. Calm, kind, respectful. As care, never as alarm or judgment. The seeker should not walk away thinking "I better not say anything that triggers the protocol." They should walk away thinking "I am safe to be honest, because I know how this person will respond." And three — where confidentiality ends. There are exactly three narrow exceptions, and you name them honestly at the start.
Here is why drawing those lines so clearly matters. It tells the seeker the truth — that honesty about what is in their head, or about their past suffering, or about their wrestling with sin and faith, will not, on its own, trigger an emergency call or a report. The narrow exceptions are about imminent danger and reportable disclosures. A guide who collapses those distinctions trains seekers to hide what they are thinking — and that is the worst possible outcome.
A template — adapt it to your voice. Same content covered in the consultation, reinforced in the first session.
"Before we start, I'd like to address a few things so there are no surprises. Most of what we talk about stays between you and me. There are a few specific situations where that changes, and I want to be honest with you about them from the start."
On thoughts of harm. "If you ever share thoughts about ending your life or hurting someone else, you can tell me honestly — sharing thoughts won't trigger an emergency response. What it will do is move us into a different kind of conversation. I would take it seriously, and we would talk about getting clinical support quickly."
On a plan. "If you ever tell me you're actually planning to do it — that you have a plan, the means, and the intent to act — I would stay with you. I would bring in 988, a trained mental health crisis counselor, on the call with us. They can talk with you directly and dispatch 911 themselves if the situation calls for it."
On an active emergency. "If harm is actively unfolding — if you've already done something, if there's a weapon in hand, if it's a medical emergency — I would call 911 directly."
On abuse of a vulnerable person. "If you ever share that you, or a child, dependent adult, or elder in your life is being abused right now, I am a mandated reporter and would make a report to the Department of Social Services."
On serious violent crimes. "If you ever disclose a serious violent crime that you have committed, or share knowledge of one that has not been adjudicated, I would report it to law enforcement."
On either report. "In any of those reporting situations, I would also let BetterFaith leadership know, and I would tell you I was making the report."
On clinical needs. "If anything ever comes up that needs clinical care, I'll tell you and help you find good Christian options in your area." [For discipleship guides, add: "Our relationship continues — we keep walking. We'd just need to re-establish care, so the clinical work stays with the therapist."]
On the emergency contact. "One last thing on the intake form. You listed [name] as your emergency contact. Do I have your permission to reach out to [name] if there is ever an emergency during one of our sessions — mental health, or something medical? Are you comfortable with that?"
This is the actual content of the framework conversation, in one place. Use it as written, or adapt it to your voice — what matters is that the seeker hears the substance: the distinct paths, the specific actions, and the tone of care.
Walk through it slowly. Pause after each section. Watch the seeker. The first three sections — thoughts, plan, active emergency — name the three points on the suicidality spectrum and the three different responses each gets. That distinction is the most important one in this whole document, and the seeker is hearing it now, calmly, before they are ever in it.
The two reporting sections — abuse and violent crimes — name the two separate mandated reporting paths. Some guides forget the violent-crimes piece because it is less common. Name it anyway. The seeker hears it once now, so they are never surprised by it later.
The clinical-care line has a track-specific addition that does two things at once. Both tracks say "I'll help you find good Christian options in your area." For discipleship guides, that line is followed by two paired promises — the relationship continues, and scope stays in scope. "Our relationship continues — we keep walking. The clinical work stays with the therapist. I'll keep being your guide; I won't try to be your therapist." Those two pieces are true together, and the seeker needs to hear them together. The relationship is not contingent on the seeker hiding clinical needs — and the relationship does not try to absorb the clinical work. Saying it in the framework conversation, up front, sets the expectation correctly. The seeker is never confused about what the discipleship guide does and does not do, even if they end up with a clinician later. Biblical counseling guides do not add the continuation line, because in BC the work may genuinely reach a natural closure point when clinical care is needed — saying "we keep walking" overpromises. The BC version simply names the option and stops there.
And close with the verbal yes on the emergency contact. The intake form is a record. A yes in the seeker's own voice is consent.
The central distinction in the whole crisis section. BetterFaith uses 988 and 911 differently — and which call you make changes the kind of help the seeker gets.
988 is the national Suicide and Crisis Lifeline. It is staffed by trained mental-health crisis counselors. When a seeker is at serious risk but not in an actively unfolding emergency, 988 is the right call. You bring 988 onto the video call with the seeker present. The 988 counselor can talk with the seeker directly, do safety planning in real time, and dispatch 911 themselves if the situation escalates. 988 specialists are trained to de-escalate — which is what most crisis moments actually need.
911 is for when harm is actively unfolding. An attempt in progress. A weapon in hand. A medical emergency. A seeker who can no longer participate in the conversation. 911 sends emergency responders, often including police. That response can escalate a mental-health crisis that a 988 counselor would have de-escalated. So you reserve 911 for the moments where emergency response is genuinely what the situation requires.
The clean rule. 988 for crisis support and assessment. 911 when life is actively in danger and emergency response is needed immediately. When in doubt in a non-emergency crisis, default to 988. The counselor on the other end is trained to escalate to 911 if the situation calls for it.
"Are you having thoughts of hurting yourself, or of ending your life?"
"How often are these thoughts happening, and how strong are they?"
"Do you have a plan for how you would do it?"
"Do you have access to the means — pills, a weapon, anything else?"
"Have you done anything to prepare or take a step toward it?"
"Have you ever attempted suicide or seriously tried to harm yourself before?"
The risk recognition framework. Three tiers. Notice is passive — it is listening. Ask is active — it is the direct questions. Elevate is the response. Your job ends at elevate. A clinician's job begins at assess. Stay in that lane and you will serve the seeker well.
Notice is what you hear in ordinary conversation. Statements about being a burden, hopelessness, having no reason to live, wishing they weren't here. Sudden calm or peace after a long depressive period, especially if unexplained. Giving away possessions or saying goodbye. Increased isolation, withdrawal, substance use. Direct mentions of suicide or death, even framed as a joke or hypothetical. And anger or rage directed at a specific person, especially with statements about wanting to harm them. None of these is proof. Each is a signal that Tier 2 questions are needed.
Ask is the questions in the box at the bottom. Ask them in order. Each one is asked only if the previous answer was yes or unclear. Ask calmly, slowly, without flinching — because your steadiness tells the seeker their answer is safe. If you panic, they will soften their answer to protect you. Ask the way you would ask any other honest question, because that is what this is. And remember the principle — asking does not plant the idea. It opens the door for the seeker to tell the truth.
For homicidal ideation, the same questions apply, adjusted. Are they having thoughts of harming someone specific? Is there a plan? Means? Preparation? History?
And then elevate. You match the response to what you actually heard. The next slide is the matrix.
Thoughts are not imminent danger. Many seekers share thoughts. Few are in imminent danger. The line lives in plan, means, intent, and preparation.
This is the most important slide in the deck. Sit with it. Thoughts of suicide or harm are not the same as imminent danger. Many seekers will share thoughts. Few will be in imminent danger. The line lives in four things — plan, means, intent, and preparation. The seeker's answers set the response.
Path A. Active emergency unfolding. An attempt is happening. A weapon is in hand. A medical emergency. The seeker is intoxicated or dissociated and cannot participate. You stay with them on the call. You call 911 directly. You contact the emergency contact in parallel, but 911 comes first. Document afterward. Notify leadership.
Path B. Plan, means, and intent are present, but the situation is not actively unfolding. The risk is real and serious. The situation is still a conversation. You stay with the seeker. You bring 988 onto the call — three-way the line into the session with the seeker present. Introduce the situation briefly, then let the 988 counselor lead. Stay on the line. Let them do their work. If it escalates, the 988 counselor can dispatch 911 themselves. Contact the emergency contact in parallel if appropriate. Document. Notify leadership.
Active ideation without plan. The seeker has shared thoughts but said no to plan, means, and preparation. Stay calm. Affirm that they were brave to say it. Tell them this is the kind of thing BetterFaith elevates to clinical care — reference the framework conversation. Provide three Christian clinical providers in their ZIP. Encourage scheduling a consultation within 24 to 48 hours. Ask about their support system. Let them know 988 is available any time if their thoughts intensify when they are alone. Schedule a follow-up within 48 hours. Document. Notify leadership.
And the callout at the bottom — passive ideation or past history surfacing. Take it seriously, because passive can shift to active without warning. Recommend clinical providers. Make sure 988 is in their pocket. And keep walking with them as their guide. Elevation of care does not, by itself, end the relationship — that question lands a bit differently on each track, and we'll get to it on Slide 11.
A report to DSS for abuse of a vulnerable person. A report to law enforcement for a serious violent crime. Different agencies, same parallel notification to leadership.
Mandated reporting has two paths. Both are protective, never punitive. The report is what gets a vulnerable person to safety, or what makes a community safer from an unaddressed harm.
Path A. Abuse of a vulnerable person. A report to the Department of Social Services is required when three things are true together. The abuse is current and ongoing — it is happening now, not years ago. The victim falls into a protected category — a child under 18, a dependent adult who cannot protect themselves, or an elder, 65 or older. And the disclosure is specific enough to be reportable — there is a person, a relationship, a pattern. When all three are present, a report is required.
Things that don't, by themselves, trigger DSS. Historical abuse where the abuser is no longer in the picture and no one else is at risk — that is a pastoral and possibly clinical conversation. Harm between able-bodied adults where the victim is not in a protected category — that is domestic violence; you support the seeker and connect them to domestic violence resources. A vague suspicion with no specifics — that is not yet a disclosure; you ask honest follow-up questions.
Path B. Serious violent crimes. A report to law enforcement is required when a seeker discloses a serious violent crime — either one they committed, or one committed by someone else that has not been adjudicated. Homicide, attempted homicide, sexual assault, aggravated assault, kidnapping, and similar.
What does not trigger law enforcement. Past crimes that have been adjudicated — the system has done its work. Non-violent crimes — theft, fraud, drug use the seeker is confessing as part of repentance. And general confessions of sin without a specific crime in view. A seeker wrestling with what they did, in general terms — anger, lust, broken relationships — is not making a criminal disclosure. The guide receives that as part of the spiritual care they are there to give.
Both paths include parallel notification to BetterFaith leadership. And in both, when you can't tell whether the criteria are met, you consult before deciding. You are never alone in the judgment, but the judgment is still yours.
Stay present. Communicate what is about to happen. Follow through. The report and leadership notification happen in parallel, same day.
"Thank you for telling me. I know that took a lot. I want to be honest with you about what happens next — what you just shared is the kind of thing I'll be reporting [to the Department of Social Services / to law enforcement]. I'll also let BetterFaith leadership know. The reason I'm doing that is because the report is what protects [you / the person you described / your community]. I'm not stepping out of your corner — I'm doing what care looks like in this kind of situation. We talked about this at the start. I just want to make sure you know it's happening, and why."
"Is there anything you want me to know before I make that call?"
A seeker has just disclosed something that meets the reporting criteria. In that moment, your job is threefold.
First, stay present. Do not become alarmed. Do not pivot straight to logistics. Do not stop listening. The seeker has just trusted you with something hard — receive it, reflect that you heard it, affirm that they were right to share.
Second, communicate what is about to happen. The script on the screen is one way to say it. Tell the seeker plainly that what they shared is the kind of thing you will be reporting — DSS or law enforcement depending on the path. Tell them you will let leadership know. Tell them the point of the report is protection. Do not hide the report. Do not make it secretly after the session. Do not ask permission — the report is not optional, and asking permission implies it is. Be honest, calm, and specific.
Third, follow through with the two-track response. You make the report directly — DSS for abuse, or law enforcement for the violent crime. Not routed through leadership first. At the same time, you notify BetterFaith leadership, so they can support you and make sure documentation is complete. Both happen. You don't choose between them.
The seeker may react with relief, anger, fear. All of that is normal. Your job is not to manage the reaction. It is to make the right call, communicate honestly, and stay present.
Most elevations are not crises. They happen any time a seeker's needs require clinical mental-health support beyond what spiritual care provides — depression that isn't lifting, anxiety beyond what pastoral conversation reaches, trauma needing therapy, eating disorders, substance use, mania or psychosis, OCD, complex grief. Both tracks make the referral the same way. What differs is what happens to the relationship.
Section five — elevation of care. Most elevations are not crises. They happen any time a seeker's needs call for clinical mental-health support beyond what spiritual care provides. Depression that will not lift. Anxiety or trauma beyond what pastoral conversation is reaching. Eating disorder behaviors. Substance use. Symptoms of mania or psychosis. OCD. Complex grief. None of this is something to fear, and you do not need to predict it. You just have to be ready for it if it surfaces. You do not have to be sure, and you do not need to diagnose to elevate. If something feels beyond your scope, that is reason enough.
And this is one of the few places this deck speaks to the two tracks separately. The mechanics of making the referral are identical — Psychology Today, three options, the seeker reaches out, you follow up. What differs is what happens to the relationship.
For discipleship guides — the relationship continues. Discipleship is a long-arc walking relationship. Clinical needs do not disqualify someone from being discipled. The clinical care addresses what discipleship cannot. The discipleship continues addressing what clinical care does not. The two are complementary, not competing. The line on the screen is the one a discipleship guide says aloud — "we can keep walking together." Say it explicitly. Say it warmly. The seeker may have been afraid that admitting a clinical need would end the relationship they have started to value. Name that it doesn't.
And this is the critical piece — especially for discipleship guides. Continuing the relationship through elevation requires that scope of practice is re-established and maintained. Continuing alongside is not free. There is a real risk for the discipleship guide at this moment, because you know what the seeker is walking through, you care about them, and it can feel natural to want to help with the clinical piece too. You don't. The clinical work belongs to the therapist. The discipleship work — prayer, Scripture, presence, formation — continues, but it does not cross into the clinical work. You do not ask about the seeker's diagnosis or treatment plan beyond what they freely share. You do not critique the therapist's approach. You do not try to integrate clinical and spiritual in ways that blur the lines. When the seeker brings clinical content to you, you receive it pastorally — and when appropriate, you gently say something like "that sounds important to bring to your therapist this week." Staying in scope is what makes the continuing relationship sustainable and good for the seeker. Without it, you risk doing harm even with the best intentions — by competing with the clinician, by confusing the seeker about who handles what, or by stretching yourself into territory you are not equipped for. The discipleship continues. Your scope does not change.
For biblical counseling guides — the arc often reaches its natural close. Counseling was built around a specific issue. When that issue surfaces a clinical need that BC cannot reach, the most faithful thing the work does is recognize its limit and walk the seeker to the door of someone equipped to help. That is not a failure. The seeker leaves more grounded than they came, pointed toward the next right step. The line on the screen is the BC version — "we've done good work together." Honor what was built. Make a warm handoff. Be ready to celebrate that as a good outcome.
Both are good outcomes, just shaped differently. Both tracks see elevation as faithfulness to scope, not failure.
BetterFaith uses Psychology Today's directory to refer seekers to clinical mental-health providers in their area. The process is designed to give the seeker agency and a real choice.
The Psychology Today referral process. This is the single most-used procedure in this whole deck — because elevation of care is the most common reality you will encounter. Memorize the shape.
Step one — filter by ZIP code. Use the seeker's ZIP code from the intake form to search Psychology Today for therapists in their area. The directory is publicly searchable and free to use.
Step two — filter for Christian therapists. Psychology Today has filters for faith-integrated care, including Christian therapists. Use them. Having a clinician who shares the faith framework matters — for the discipleship seeker continuing alongside the guide, and for the counseling seeker being handed off into a faith-consonant next step.
Step three — identify three options. Not one. Three. This is the rule. One option from a guide can feel like a verdict. Three give the seeker a real choice. They get to look at each profile, sense fit, and pick the person who feels right. That choice is meaningful for the success of the clinical work.
Step four — the seeker reaches out. You do not call the therapists for them. The seeker contacts the providers themselves to schedule consultations. That step is part of taking ownership of their own care. Some seekers will hesitate. That is normal. Encourage them, but the action is theirs.
Step five — follow up. In the next session, ask how the outreach went. If they have not followed through, revisit gently. The recommendation is meaningful enough to bring up more than once.
One practical note. If three Christian options are not available in their ZIP code, expand the search radius. If you still cannot find three, two is acceptable. If only one is available, name that honestly and offer it alongside non-Christian licensed therapists as alternatives. The seeker decides what they prefer.
The procedure quick reference for the four operational moments that aren't Psychology Today. Memorize the shape of each.
Reporting to DSS. The line varies by state — use the one for the state where the abuse is occurring, not where you are. State child protective services and adult protective services hotlines are publicly listed; BetterFaith maintains a quick-reference contact list. Same day if possible, within 24 hours at the outside. Share what was disclosed. You are not investigating — only reporting. Capture the case number. Notify leadership in parallel, same day.
Reporting to law enforcement. For most disclosures, the non-emergency line for the local police department in the jurisdiction where the crime occurred is the right starting point. If the crime is currently in progress or imminent, that's 911. Same-day report. Capture the case number. Notify leadership.
Calling 988 with the seeker present. Tell the seeker calmly that you want to bring in someone who can help in the moment — a trained crisis counselor at 988. Dial 988 on your phone and bring the call into the video session — most platforms support three-way calling or speakerphone bridging. Introduce the situation briefly to the 988 counselor, then let them lead the conversation with the seeker. Stay on the line. Don't disappear. If three-way calling isn't technically possible, have the seeker call 988 themselves while staying on the session with you. The goal is the seeker connected and not alone.
Calling 911. When harm is actively unfolding. When a medical emergency is happening — overdose, seizure, heart attack, fall, fainting. When the seeker is intoxicated, dissociated, or unable to participate and the situation calls for immediate intervention. When 988 is already on the line and escalates — they dispatch 911 themselves. Provide location if known, nature of the emergency, stay on the video call until help arrives.
And the protection at the bottom. Good Faith Immunity. When a guide acts in good faith to protect a life or fulfill a reporting obligation — calling 988 or 911, contacting an emergency contact, reporting to DSS, reporting to law enforcement, breaching ordinary confidentiality to protect someone — that action is protected. The law has your back. The protection exists precisely so that you can act decisively when life or safety is on the line, without hesitating over consequences. Act when the moment calls for action.
The work isn't over when the immediate moment ends. How you care for the seeker — and for yourself — afterward matters.
For the seeker. Reach out within 48 hours with a short, warm message. "Just thinking of you — how are you today?" The shape of what continues after looks different on each track. For discipleship, the relationship continues as it has been — the discipling itself keeps going, with clinical care added alongside. For biblical counseling, the formal counseling arc may close out as the seeker moves to clinical care — but the human warmth continues: a follow-up message, a transition prayer, an open door, real attention to how the handoff is landing. Neither track abandons the seeker after a hard moment. In the next session — or in the post-handoff follow-up for BC — ask honestly how the next steps went. The referral, the report follow-up, the 988 safety plan. Don't pretend it didn't happen. Reference it with normalcy, because avoiding it can make the seeker feel ashamed.
For yourself. Walking with someone through a crisis, a disclosure, or an elevation is heavy. It does not leave you untouched. Caring for yourself is not optional — it is part of being able to keep doing this work. Debrief with BetterFaith leadership soon after, same day if you can. Pray — the same gospel you point seekers toward holds you, too. Notice your own emotional weather in the days after. Sleep, appetite, tension, intrusive thoughts about the conversation. Those are normal responses, but they need attention. And if you need a slower week or a short pause from new sessions, that is reasonable. Take it.
And then — document. Promptly, while details are fresh. What was observed, what questions were asked, how the seeker responded, what action was taken, what the next steps are. For 988 calls, capture the date, time, and any safety plan. For DSS or law enforcement reports, also capture the date and time of the call, who you spoke with, and the reference or case number. Documentation protects everyone — the seeker, by creating continuity of care; you, by creating a clear record; and BetterFaith, by demonstrating responsible practice.
Report when reporting is what care looks like. Walk with the seeker through whatever comes next — whether that is continuing alongside them or handing them off into the right kind of help. And trust that God, who loves the seeker more than you ever could, is still at work, even in the hardest moments.
Three words to carry it. Notice. Ask. Elevate.
Most of what we've covered, you may never use. That is good. The point of preparation was never that crisis becomes likely — the point is that if a hard moment ever does come, you are ready, and the seeker is already prepared from the very first conversation you had together.
Stay in scope. Notice with care. Ask with steadiness. Call 988 for crisis support. Call 911 when life is actively in danger. Report when reporting is what care looks like. Walk with the seeker through whatever comes next — whether that means continuing alongside them on the discipleship side, or handing them off well into the right kind of help on the biblical counseling side. Neither track abandons the seeker. Both honor what spiritual care is — and what it is not.
And remember the truth that holds this whole document. You are not the seeker's savior. You are not their last hope. You are a guide — present, faithful, attentive, in scope. The Holy Spirit does the work that only He can do. And God, who loves the seeker far more than you ever could, is still at work, even in the hardest moments. You are not carrying this alone. Thank you for the care you bring to it.